The overall incidence of
nephrolithiasis-related acute and
chronic renal failure is poorly known and surely underestimated. However, obstructive nephropathy represents a potentially curable form of
kidney disease that often requires for managing an instrumentation of urinary tract.
Rasburicase is an
enzyme that transforms
uric acid to
allantoin, a compound more water soluble that will be excreted by the kidney more easily.
Rasburicase has been proven to be an effective
therapy for prevention of
tumour lysis syndrome. But it also represents an interesting new option in managing
hyperuricemia in patients with severe tophaceous
gout. We administered
rasburicase intravenously (0.20 mg/kg/day, for 2 days) in 2 adults with acute obstructive nephropathy from
renal calculi, which was receiving temporary haemodialysis.
Rasburicase produced a sharp
polyuria 12-18 hours after its administration accompanied with a fast reduction of serum
creatinine levels, that returned to normal range without further dialysis. If we suppose that
rasburicase can pass through glomerular filter by its relatively low molecular weight, it could dissolve tubular
uric acid crystals in
acute renal failure associated to
tumour lysis syndrome, providing the restoration of renal function. But we also could postulate that
rasburicase can act in urinary tract, fragmentating
renal calculi, promoting relief of obstructive uropathy and the resolution of
renal failure. We suggest
rasburicase should be tried in this new indication to prove its potential efficacy.